Project Summary One-in-five unintended pregnancies worldwide occurs in sub-Saharan Africa, but we know little about the African women who have unintended pregnancies, how they respond to them, and whether the births that result put women, and their children, at risk of poor health. The proposed research will offer a comprehensive look at the determinants of unintended pregnancy and the health consequences for women and the resulting children in Malawi. The study will address many of the challenges that have stalled this area of research. Rather than using women's reports after a child is born to classify births as unintended, as most existing studies do, the project will use women's pregnancy intentions expressed just before conception to identify the prospective determinants of unintended pregnancy and women's emotional responses to it (Aim 1). The study will then examine if unintended childbearing is tied to health disadvantages for women (Aim 2) and their resulting children (Aim 3). To complete these aims, the study will combine two phases of the NICHD-funded Tsogolo la Thanzi longitudinal study (2009-11; 2015) to assemble a dataset that features measures of women's fertility intentions measured an average of two months before conception, pregnancies identified through urine hCG tests, women's emotional responses to unintended pregnancy soon after conception, birth and non-live birth outcomes, women's health spanning pre-conception to 3 to 5 years after giving birth, and children's health from infancy through ages 3 to 5 years. Results will illuminate the determinants of unintended pregnancy and whether, and if so under what circumstances, unintended births contribute to women's and children's poor health outcomes in a resource-poor setting. The findings will enable practitioners to better target family planning programs toward women at greatest risk of unintended, and unwelcomed pregnancies, and will help clinicians target interventions toward the pregnant women at greatest risk of adverse maternal and child outcomes.